Bonnie, a 70-year-old woman, arrives at the outpatient oncology clinic to learn about treatment options for stage IIB small cell lung cancer.
She is accompanied by her husband of 45 years. During the intake process, Bonnie tells Daryl, an oncology nurse, that despite her new lung cancer diagnosis, she just can’t seem to find the willpower to quit smoking. She says, “I’ve been smoking a pack a day for 50 years; what’s the point of stopping now? The damage is done.”
What Would You Do?
Studies show that being diagnosed with lung cancer does not inevitably result in a person’s desire or ability to stop smoking or using tobacco products. Data indicate that 90% of all lung cancer cases are related to smoking, yet estimates from smoking cessation studies cite that 50%–80% of patients continue to smoke after a lung cancer diagnosis.
Patients with lung cancer who were smoking at diagnosis and manage to quit stand to benefit in both the short and long term (see Figure 1). Surprisingly, studies also show that healthcare providers do not have a good track record for adequately helping patients stop using tobacco. Provider-identified barriers include not being up to date on tobacco cessation guidelines and a lack of knowledge and skill in providing smoking cessation support to help patients stop using tobacco and begin reaping the benefits of being smoke free.
Daryl recently read an article in the Clinical Journal of Oncology Nursing outlining the five A’s (ask, advise, assess, assist, arrange) and five R’s (relevance, risks, rewards, roadblock, repetition) of tobacco cessation. Because Bonnie was not outwardly expressing a desire to quit, Daryl chose to follow the five R’s strategy.
He asked Bonnie about previous attempts to stop smoking and learned that she had tried multiple times, and prior to her diagnosis, believed she would benefit by not smoking (relevance). This gave Daryl an opening to begin explaining the many ways patients with lung cancer can profit by no longer smoking. Bonnie identified using smoking to reduce stress and the fact that her husband also smoked as risks and roadblocks to her cessation success.
At this point, Bonnie’s husband spoke up and expressed his interest in getting rid of the smoking habit “once and for all.” Daryl provided the couple with a list of smoking cessation resources and urged them to talk with Bonnie’s oncologist about short-term use of prescription medications shown to aid people when choosing to stop smoking.